Public Health and Social Justice in the Age of Chadwick (review)

Abstract

Reviewed by: Public Health and Social Justice in the Age of Chadwick * Joanne Abel Goldman (bio) Public Health and Social Justice in the Age of Chadwick. By Christopher Hamlin. New York: Cambridge University Press, 1997. Pp. vii+368; figures, notes/references, bibliography, index. $64.95. Christopher Hamlin’s Public Health and Social Justice in the Age of Chadwick is a welcome new look at the manner in which mid-nineteenth-century cities in Great Britain perceived and acted upon the unhealthy conditions that prevailed in them. Hamlin challenges the simple proposition that economic change and urban growth in the eighteenth and nineteenth centuries created impoverished people who lived in squalor and that the unacceptableness of their condition led to change. He instead convincingly asserts that Chadwick’s efforts to relieve the insalubrious conditions of British cities were the consequence of changing notions of disease, poverty, urban administration, and urban responsibility. Yet he rejects what he humorously calls “The Sanitarian’s Progress,” the notion that Chadwick’s influential Sanitary Report directly led to the creation of the General Board of Health, which naturally facilitated the construction of an infrastructure of water supply and drainage that cleaned up the cities of Great Britain. Rather, Hamlin places Chadwick in the intellectual milieu of mid-nineteenth-century Great Britain, where new notions of municipal government challenged prevailing ideas about public health and the poor and the existing institutions that managed them. Chadwick’s efforts to bring about reform reveal a complex society shaped by frustrating personalities, party politics, and conflicting priorities that then, as today, generated urban policy. Hamlin lays out his argument in a clear fashion. The first two chapters consider the mid-nineteenth-century intellectual climate that perceived social problems to be inherently medical and, therefore, fundamentally correctable. Medical problems could be fixed by social reform. Chadwick challenged this assumption in his famous Sanitary Report, and Hamlin discusses its genesis, thesis, and evidence. Simply put, Chadwick conceived of a system that integrated water supply with wastewater removal. These wastes would then be sold to outlying farms to be used as fertilizer, thus allowing the municipality to recoup the costs it incurred when building the system. Hamlin then shows how reform was implemented, after which he examines the limits of these reforms, in particular, how and why the improvements fell so far short of Chadwick’s vision. The strength of this book is that it places nineteenth-century public health reform in the context of a dynamic political, economic, and intellectual climate. Chadwick’s technological solutions to the public health crisis challenged assumptions about the social, economic, and spiritual causes of disease. His campaign for technological solutions that demanded centralized management challenged the decentralized, parish-based form of local [End Page 176] government. One of Chadwick’s greatest difficulties was that he campaigned for these changes without the support of a cohesive medical, engineering, or political community. This work complements recent urban historiography, which celebrates the complexity of nineteenth-century urban policy. My own work on the campaign to introduce a comprehensive sewer system into New York City found that the forces that delayed improvement in the Empire City were quite similar to those that Chadwick confronted. Since local wards held the power to initiate policy, their programs reflected the interests of their particular constituencies. Only after crisis, investigation, and cohesive lobbying did the state intervene and create new mechanisms of management that usurped the authority of local ward politics. This centralized authority, with the power to manage as well as coerce compliance, could, and finally did, introduce a system of planned and integrated sewers. In contrast, Chadwick’s program was not fully realized. One key difference between the New York and British campaigns for public health reform was the role of key interest groups. Physicians and engineers faced important professional challenges in the mid-nineteenth century and became key players in bringing about infrastructural reform in New York. “Scientific physicians” appealed to the general public and state authorities to clean up the city. Civil engineers joined forces with the physicians and called for sewerage reform, in which they would assume central roles in public works administration. Hamlin does not give us much...